Academic journal article Iranian Journal of Public Health

Frequency and Susceptibility of Bacteria Caused Urinary Tract Infection in Neonates: Eight-Year Study at Neonatal Division of Bahrami Children's Hospital, Tehran Iran

Academic journal article Iranian Journal of Public Health

Frequency and Susceptibility of Bacteria Caused Urinary Tract Infection in Neonates: Eight-Year Study at Neonatal Division of Bahrami Children's Hospital, Tehran Iran

Article excerpt

Abstract

Background: Susceptibility pattern of organisms causing urinary tract infection (UTI) in neonate would potentially improve the clinical management by enabling clinicians to choose most reasonable first line empirical antibiotics. This study aimed to this end by studying isolated organisms from neonates with UTI in an inpatient setting.

Methods: Current retrospective study has recruited all cases of neonatal UTI diagnosed through a suprapubic/ cathe- terized sample, admitted to Neonatal Division of Bahrami Children's Hospital, Tehran, Iran, from June 2004 to June 2012.

Results: Escherichia coli was the dominant (64.4%) bacteria among a total of 73 cases (69.9% boys and 30.1% girls; aged 14.14 ± 7.68 days; birth weight of 3055.85 ± 623.00 g) and Enterobacter (19.2%), Klebsiella (12.3%), and Staphylococcus epidermdisis (4.1%) were less frequent isolated bacteria. E. coli was mostly resistant to ampicillin (93.6%), cefixime (85.7%) and cephalexin (77.3%), and sensitive to cefotaxime (63.6%). Enterobacter found to be most resistant to amikacin (100%), ampicillin (92.85%), and most sensitive to ceftizoxime (71.4%).

Conclusion: A high ratio (> 92.85%) of resistance toward ampicillin was observed among common neonatal UTI bacterial agents. Having this finding along with previous reports of emerging resistance of neonatal uropathogens to ampicillin could be a notion that a combination of a third generation cephalosporin and an aminoglycoside would be a more reasonable first choice than ampicillin plus an aminoglycoside.

Keywords: Urinary tract infection, Neonates, Antimicrobial susceptibility, Hospital, Iran

Itroduction

UTI is a common problem in infants and young children (1, 2); however, its frequency, symptoms and causative organisms varies in accordance with sex, age, and gender (3). Unlike other age groups neonates present with non-specific signs and symptoms (4) warranting a complete sepsis workup followed by a 7 to 14 day-course of anti- biotic therapy (2), typically parenteral ampicillin plus an aminoglycoside (5) or a third-generation cephalosporin (6, 7). Recent reports on emerging patterns of resistance toward empirical antibiotics (8-12), especially ampicillin (13-17), have made the early choice of antibiotics a more challenging deci- sion (8). The criticalness of issue lies in the fact that those diagnosed earlier and treated according- ly, are less likely to bear long-term consequences imposing an increased burden on health care sys- tems (18).

Clinical manifestations of UTI in neonates are mostly non-specific and of a systemic nature (15) like fever, irritability, lethargy, vomiting, growth failure, abnormal urination- namely oliguria, poly- uria or malodorous urine, and jaundice (14, 19-21). the non-specific presentations often make UTI hard to diagnosis; however, its reported preva- lence ranges from 4- 25% (22) in in very low weight infants (birth weight ? 1000 g) to 0.1-1% in term infants (23). Additionally, UTI in new- borns could lead to urosepsis or neonatal sepsis that is why it is often managed as a case of sepsis (24).

Most UTIs in infants are caused by gram-negative bacilli (23, 25-27). E. coli has been the most preva- lent organism causing UTI in all ages including neonatal period (1, 21, 28-30) accounting for as many as 80% of isolates in many studies (25). Other Enterobacteriaceae causing UTI in neo- nates include Klebsiella, Enterobacter, Citrobacter, Pro- teus, Providencia, Morganella, Serratia, and Salmonella (6, 26, 27). Gram-positive bacteria like Staphylococ- cus and Enterococcus have less been retrieved from neonates with UTI (2, 26).

Appropriate management essentially mandates knowledge of most prevalent pathogens along with their susceptibility pattern. This is not possi- ble unless a continuous surveillance is done and let therapeutic choices to be updated accordantly. Having said that, it is an accepted practice that neonatal units" take into account their prevailing antibiotic sensitivities of local bacterial isolates" (31, 32). …

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